Provider Demographics
NPI:1194096131
Name:STO DOMINGO, ERIC ALBERT ABELLA (OTR)
Entity type:Individual
Prefix:
First Name:ERIC ALBERT
Middle Name:ABELLA
Last Name:STO DOMINGO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13649 CYGNUS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9325
Mailing Address - Country:US
Mailing Address - Phone:407-575-0546
Mailing Address - Fax:
Practice Address - Street 1:13649 CYGNUS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9325
Practice Address - Country:US
Practice Address - Phone:407-575-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist